| NPI | 1639788276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL MA104109) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: TX MT120363) |
| Enumeration Date | 2020-07-29 |
| Last Update Date | 2025-07-28 |